Evaluating the Implementation of a Translational Peer-Delivered Stress Management Program for Spanish-Speaking Latina Breast Cancer Survivors

Abstract

Information is needed on implementation processes involved in translating EBIs into health disparity communities. In an RCT, Nuevo Amanecer, a cognitive-behavioral stress management (CBSM) program delivered by breast cancer survivors (compañeras) in community settings to Spanish-speaking Latina breast cancer survivors, was effective in improving quality of life and decreasing breast cancer concerns and depressive and bodily symptoms. Using mixed methods, we evaluated the processes of implementing Nuevo Amanecer. Program delivery was assessed by direct observation. Treatment receipt was assessed by participants' mastery and homework completion. Perceived benefits, quality, ease of use, usefulness of components, and suggested improvements were evaluated through participant surveys and semi-structured interviews of participants and compañeras. Eighty percent of women completed 6 or more of 8 sessions. Observer ratings of program delivery indicated compañeras demonstrated fidelity 80-90% of the time for three components (e.g., following the manual), but only 10% for two components (e.g., modeling skills). Regarding treatment receipt, most participants completed all homework. Knowledge and skills mastery was high (mostly >85%). In program evaluations, 93% indicated the program helped them cope with breast cancer "quite a bit/extremely." Participants reported improved self-management skills and knowledge. Suggested improvements were to add more sessions to practice cognitive-behavioral coping skills and simplify exercises and homework. We conclude that CBSM programs can be delivered in community settings by trained peers with high fidelity, acceptability, and perceived usefulness. Results provided some areas where the program could be improved.Our rigorous evaluation illustrates methods for evaluating processes of translating EBIs for community implementation.

Translating a stress management intervention for rural Latina breast cancer survivors: The Nuevo Amanecer-II

“…Step 3 in the framework includes reviewing evidence-based interventions, systematic reviews, evidence-based guidelines, and other evidence (e.g., optimal delivery modes) to inform the intervention. This comprehensive level of review was conducted to develop NA [30, 32]. For this study, the focus was on refining and tailoring NA for a new setting and population.…”

“…Participant surveys and semi-structured interviews were used to assess perceived benefits, quality, ease of use, usefulness of components, and suggested improvements. Debriefing interview results are described in detail elsewhere [32]. Briefly, the following recommendations were made: 1) increase self-management skills practice (healthy lifestyles, ability to cope with stress); 2) better address limited literacy; 3) simplify medical terminology; and 4) include participants’ families.…”

“…Utilizing this strategy in a prior study, a community-based participatory randomized controlled trial (RCT) was conducted to develop and test a CBSM intervention ( Nuevo Amanecer-A New Dawn , hereafter referred to as NA ) for recently diagnosed, urban, Spanish-speaking Latina breast cancer survivors [30–32]. The eight-week NA program is a culturally tailored, peer-delivered intervention that teaches cognitive-behavioral coping skills to survivors, to manage stress and emotions.…”

A Vision for Improving Quality of Life Among Spanish-Speaking Latina Breast Cancer Survivors

“…Because of the extensive involvement of community advocates, survivors, and cancer care providers throughout translation, broad program dissemination should reduce ethnic disparities in psychosocial health. Our Nuevo Amanecer process evaluation indicates that it was precisely this careful integration of community input that resulted in a program that effectively reduced disparities in the psychosocial health of vulnerable Latinas in the study by meeting their needs and anticipating implementation barriers [25]. On study completion, we will post our program products on Internet sites to further disseminate them and to maximize the community benefit derived from these studies.…”

The importance of patient engagement to quality of breast cancer care and health-related quality of life: a cross-sectional study among Latina breast cancer survivors in rural and urban communities

“…Compared to white breast cancer survivors and more acculturated Latinas, less acculturated Latina breast cancer survivors report less involvement in treatment decision making, greater treatment decision making regret, less satisfaction with breast cancer care information provided, a more limited understanding of their diagnosis and treatment, lower self-efficacy for interacting with physicians, and worse patient-physician relationships [11][12][13][14][15][16]. Among Latina breast cancer survivors, greater English proficiency was associated with better communication effectiveness specific to treatment decision making, and better communication predicted greater satisfaction, which, in turn, predicted better quality of life [17].…”